The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery
Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States American Journal of Obstetrics and Gynecology
(Impact Factor: 4.7).
10/2005; 193(3 Pt 2):1016-23. DOI: 10.1016/j.ajog.2005.05.066
The purpose of this study was to determine which factors influence the likelihood of successful trial of labor (TOL) after 1 previous cesarean delivery (CD).
We performed a multicenter 4-year prospective observational study (1999-2002) of all women with previous CD undergoing TOL. Women with term singleton pregnancies with 1 previous low transverse CD or unknown incision were included for analysis.
Fourteen thousand five hundred twenty-nine women underwent TOL, with 10,690 (73.6%) achieving successful VBAC. Women with previous vaginal birth had an 86.6% success rate compared with 60.9% in women without such a history (odds ratio [OR] 4.2; 95% CI 3.8-4.5; P < .001). TOL success rates were affected by previous indication for CD, need for induction or augmentation, cervical dilation on admission, birth weight, race, and maternal body mass index. Multivariate logistic regression analysis identified as predictive of TOL success: previous vaginal delivery (OR 3.9; 95% CI 3.6-4.3), previous indication not being dystocia (CPD/FTP) (OR 1.7; 95% CI 1.5-1.8), spontaneous labor (OR 1.6; 95% CI 1.5-1.8), birth weight <4000 g (OR 2.0; 95% CI 1.8-2.3), and Caucasian race (OR 1.8, 95% CI 1.6-1.9) (all P < .001). The overall TOL success rate in obese women (BMI > or = 30) was lower (68.4%) than in nonobese women (79.6%) (P < .001), and when combined with induction and lack of previous vaginal delivery, successful VBAC occurred in only 44.2% of cases.
Previous vaginal delivery including previous VBAC is the greatest predictor for successful TOL. Previous indication as dystocia, need for labor induction, or a maternal BMI > or = 30 significantly lowers success rates.
Available from: ncbi.nlm.nih.gov
- "Approximately 73.6 - 75.5% of women who opt for VBAC will have a vaginal delivery 5, 6. If successful, VBAC has been shown to be associated with a lower incidence of maternal febrile mortality, need for blood transfusion and hysterectomy. "
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ABSTRACT: Background: The purpose of this research is to discover whether measurement of cervical length and cervical volume at term is helpful in predicting the onset of labor in VBAC candidates.
Methods: Transvaginal sonographic evaluations of the cervixes of pregnant women who desired to undergo VBAC were performed between 36 - 40 weeks gestation. Clinical information such as labor onset time, gestational age at delivery and delivery mode was gathered from medical records.
Results: A total of 514 pregnant women participated in this study. Cervical length was significantly longer in the group that delivered 7 days or more after measurement than in the group that delivered within 7 days of measurement (43±0.77 cm vs. 2.99±0.72 cm, p< 0.001). Cervical volume was significantly larger in the group that delivered at and after 7 days than in the group that delivered within 7 days (29.21±11.62 cm3 vs. 34.07±13.41 cm3, p=0.014). The cervical length ROC curve was significantly more predictive than the cervical volume ROC curve (AUC: 0.711 vs 0.594, p= 0.001). There were no significant differences between the combined cervical length/volume ROC curve and the cervical length ROC curve alone (p= 0.565). The AUC of the cervical length ROC curve to predict postterm pregnancy was 0.729.
Conclusion: Measuring cervical length is helpful in predicting the onset of spontaneous labor within 7 days and posterm delivery in VBAC candidates.
International journal of medical sciences 10/2012; 9(9):738-42. DOI:10.7150/ijms.5042 · 2.00 Impact Factor
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ABSTRACT: L’utérus cicatriciel est devenu le premier motif de césarienne itérative. Le risque de rupture utérine est estimé autour de
0,7 ‰, et environ 600 césariennes seraient nécessaires pour éviter une complication néonatale grave. Parallèlement, la morbidité
maternelle a augmenté par les anomalies d’insertions placentaires, responsables de complications hémorragiques graves. Il
convient de discuter avec le couple de la voie d’accouchement en cherchant d’abord à identifier d’emblée toute contre-indication
à la voie basse, puis les arguments favorables au succès de celle-ci. En cas de césarienne prophylactique, on attendra 39
SA pour diminuer la morbidité respiratoire fœtale. En cas de déclenchement, il faudra respecter les recommandations de la
Haute Autorité de Santé (HAS) et informer la patiente du risque majoré de rupture utérine.
Scarred uterus became the first motive for iterative cesarean. The risk of uterine break is considered near 0.7‰ and approximately
600 cesarians would be necessary to avoid a neonatal serious complication. At the same time, the maternal morbidity increased
by the abnormalities of placental insertions is responsible for important haemorrhagic complications. It is advisable to discuss
with the couple of the way of delivery by trying at first to identify at once any contraindication for trial of labor and
then the favorable arguments for his success. In case of preventive cesarean, we shall wait for 39 weeks to decrease the fetal
respiratory morbidity. In case of release, it will be necessary to respect official recommendations and to inform the patient
of the risk increased by uterine break.
Mots clésUtérus cicatriciel-Épreuve du travail-Intention de voie basse-Rupture utérine-Déclenchement du travail
KeywordsUterine scar-Trial of labor-Previous cesarean-Uterine rupture-Labor induction
Revue de médecine périnatale 03/2010; 2(1):12-18. DOI:10.1007/s12611-010-0056-x
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ABSTRACT: The aim of this study was to evaluate the rate of vaginal birth after a previous cesarean in our population. A retrospective study was performed through a review of the clinical histories of the 258 women with a previous cesarean section that delivered in our hospital between 2005 and 2007. Women with more than one prior cesarean section, classical uterine incision or any absolute contraindication for vaginal delivery were excluded. Delivery was through the vaginal route in 59.3%. Fifty-five percent of the women began spontaneous delivery, 21.7% were induced and cesarean section was scheduled in 23.3%. Of the variables studied, the highest rates of vaginal birth were produced with spontaneous labor, when Bishop's score was ⩾6 (88.51%) and when there was a history of vaginal birth before a cesarean section (66.7%) or after a cesarean section (84.25%). The lowest rates of vaginal delivery (42.2%) were obtained when the previous indication for cesarean section was dystocia (no progression/disproportion). There were no cases of uterine rupture in our study and maternal and fetal complications did not increase. In conclusion, vaginal birth is feasible in almost 60% of women with a prior cesarean section and does not increase fetal and maternal complications.
Clínica e Investigación en Ginecología y Obstetricia 07/2009; 36(4). DOI:10.1016/j.gine.2009.01.002
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